Oral cancer is the sixth leading cancer in the world, and ranks in the top three cancers in countries where betel nut (also known as areca nut) chewing is common. In Micronesia, a group of Pacific Islands where betel nut is frequently chewed, the risk of oral cancer is elevated, but quite variable across populations. For the period 1985-1998 (age-adjusted to the 1988 U.S. population), the prevalence per 100,000 ranged from 4.2 in Chuuk to 31.8 in Yap. In Guam, the incidence of mouth cancer per 100,000 population for the period 1997-2003, age-adjusted to the 2000 U.S. population, varied between 8.1 for Chamorros to 17.9 among other Micronesians. The disparity in oral cancer rates among these populations may be due to differences in betel nut chewing patterns. To investigate the effect of chewing patterns, we must be able to conduct studies on multiple Micronesian islands with differing chewing patterns. Previously, we developed a comprehensive betel nut assessment protocol and a protocol for detecting oral lesions on Guam. The overall objectives of the pilot study are to further develop and test these methods, and to demonstrate that they can be applied in a research study of betel nut use on an island other than Guam. A convenience sample of 100 Micronesians (50 men and 50 women) who are long-term betel nut users (regular use for at least 10 years) will be recruited from the island of Saipan in the Commonwealth of the Northern Mariana Islands (CNMI). We will collect data on betel nut use, presence of oral precancerous lesions, diet, demographics, anthropometry, medical history, and physical activity.
The specific aims of this study are to: 1) collect information on betel nut use among study participants and other members of their families, 2) perform oral examinations, and biopsies, as needed, on study participants, 3) measure other health risks among this population, including obesity, high blood pressure, self-reported history of cardiovascular disease and diabetes, and unhealthy dietary practices and 4) examine associations of duration, frequency, and type of betel nut use with oral pre-cancers and with other health risks. This pilot project will help formulate the research methods for studying betel nut use and disease risk in Micronesia, and will provide the necessary preliminary data for a full multi-island study of betel nut use and the prevalence of oral lesions. Ultimately, a better understanding of these associations will provide important new directions for reduction of health risks through educational efforts and targeted intervention strategies.